3003 W CASINO RD BLDG 40-36 2020-01-21

/dfc - 'RECTRICAL S PERMIT APPATI®N CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98209 (P)425-257-8890 j FAX 425-257-8857 1 (E) everetteps@aeverettwa.gov www.everettwa.gov/permits PRO:OEdr? SITE IINFORMA�'I®Id1 PROJECT ADDRESS: BUILDING AREA(it residential, new construction, emodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: jOE�i�G E�C1LC t t ELECTRICAL APPLCCATiON IIVFOF-MAT90N CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES if low voltage): FIRE ALARM? El YES XNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: D COI�ITACT INFORMATION.. OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 19C7BOX 3 CRy GF STATE -01512Y—220/ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ,(J UC 7/0A CONTRACTOR ADDRESS: STREET PO 86)x CITY MIAJ ,,mL o STAIAA* ZAP �D CONTRACTOR PHONE: r5-2 0-le///- 4 // CONTRACTOR EMAIL: ,+R—j . /1?ale �rCoin CONTRACTOR LIC,#(REQUIRED): G_rnIe-=eC -7-D Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0419519 PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: A DC-71q I s ��d�/1� CONTACT EMAIL: p 14I(j',CA0 (/40 W191N1l'T', C.OfA AGREEMENT.'Thereby certify that t have read and examined this application and know the same to be true and correct. All provislons oflaws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the ownerofthls property to perform the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PERMIT# C� E �_4C� - 005 OwnerlAu orized Agen Signature Date (Revised 10/1212015)